Introduction Treatment options for multiple myeloma have increased substantially. To find the best therapy for each in-dividual patient, patient preferences should be taken into account whenever a decision regarding relapsed/refractory multiple myeloma (RRMM) treatment has to be made. Shared decision-making (SDM) is one of the keys to person-centred care. Previous research, using semi-structured interviews, investigated the ex-periences and preferences of Belgian RRMM patients and their carers regarding involvement in decisions related to treatments. The aim of this part of the PARTNER-project was to develop a model and tools to support the implementation of SDM in RRMM treatment. Methodology The practice model for SDM and the proof of concepts of the tools were developed using a 2-phase co-design approach. First, results from the interviews were combined with data from the literature to draft the model and tools. In the second phase, meetings with expert panels were set up to discuss the model and tools and to adapt them according to the feedback. Results The PARTNER model for SDM in RRMM that has been developed as part of this project is a conceptual framework, describing essential elements in the decision-making process. Four tools were designed to convert the model into practice. It concerns 1) a question prompt list, to be used by patients to prepare for consul-tations with clinicians; 2) knowledge clips for patients and healthcare professionals (HCPs) to enhance the understanding of the SDM concept; 3) a conversation starter, aimed to open the dialogue among HCPs about organising and implementing SDM; and 4) a conversation tool, which is a hands-on step-by-step guide for conversations about treatment options between HCPs and RRMM patients. Additionally, suggestions on dissemination strategies were formulated. Conclusion Efforts were made to enhance a fit of the PARTNER model and tools into the Belgian RRMM setting. For some of the tools, evidence was provided on the improvement of the decision-making process, but none of the tools were yet tested. Further research should focus on pilot testing and evaluating the tools regarding their impact and feasibility to support SDM.
Multiple sclerosis is considered to be an immune mediated inflammatory disorder of the central nervous system. It mainly affects young, socioeconomic active patients. Although our armamentarium for this disease has significantly evolved in recent years some patients remain refractory to conventional therapies. In these cases, autologous hematopoietic stem cell transplantation can be considered as a therapeutic option. Decreasing morbidity, mortality, and increasing patient awareness have led to rising inquiry by our patients about this treatment option. With the aim of a standardized protocol and data registration, a Belgian working party on stem cell therapy in multiple sclerosis was established. In this paper, we report the consensus protocol of this working party on autologous hematopoietic stem cell transplantation in multiple sclerosis.
term survival following autologous and allogeneic stem cell transplantation for blastic plasmacytoid dendritic cell neoplasm.Blood 2015; 125 (23).4. Martin-Martin et al.High frequency of occult central nervous system involvement in blastic plasmacytoid dendritic celle neoplasia at diagnosis: role for intrathecal prophylaxis?EHA abstracts 2016. 5. Philippe et al.Bortezomib as a new therapeutic approach for blastic plasmacytoid dendritic cell neoplasm.EHA abstracs 2017.6. Pemmaraju et al.Ongoing phase 2 clinical trial of SL-401 in patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN): stage 1 and stage 2 results.
Both mucosal-associated invariant and natural killer T-cell deficiency in multiple myeloma can be countered by PD-1 inhibitionMucosal associated invariant T (MAIT) cells primarily contribute to immune defense against infectious pathogens and regulate pathogenesis of various inflammatory diseases. 1They are innate-like T lymphocytes expressing an invariant TCR Vα7.2-Jα33 chain in humans and displaying high expression levels of CD161 and IL-18R.They are primarily localized in mucosal tissue and respond to vitamin B2 metabolites in an MHC class 1b (MR1)-dependent manner. 1 Despite a different ontogeny, MAIT cells share a close lineage relationship with invariant natural killer T (iNKT) cells, another invariant T-cell subset recognizing glycolipids and important for anti-tumor immunity. 1,2Moreover, it has been suggested that they share a common niche and could therefore be functionally redundant. 3Recently, MAIT cells have been implicated in cancer and were shown to support antitumor immunity; 4 however, their exact role has not been well explored.Until now, most reports on involvement of MAIT cells in cancer have been limited to mucosaassociated cancers. 5Recently, however, Wallace et al. reported MAIT cell deficiency in chronic lymphocyte leukemia (CLL), suggesting a possible involvement of MAIT cells in hematologic malignancies as well. 4Further investigation of MAIT cell functionality in cancer patients beyond mucosa-associated malignancies is, therefore, warranted.In multiple myeloma (MM), invariant T cells such as iNKT cells have been reported by us and others to be deficient. 6This has not yet been investigated for MAIT cells and whether they prove to be haematologica 2017;
Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of T-cell neoplasms presenting in the skin, Mycosis Fungoides (MF) being the most common subtype and Sezary syndrome the leukemic form. Treatment is dependant on stage and responses to previous therapy. Treatments are divided into ''skin-directed therapies'' which are first-line for early stage diseases and ''systemic therapie'' reserved for advanced stages or refractory CTCL. There are currently no curative therapies for CTCL and consecutive treatments have to be given in function of the progression of the disease. There is an urgent need for new therapies to treat symptoms, particularly pruritus and pain, and to prolong survival. This paper summarizes new drugs available for the CTCL and their mode of action. Most new drugs for CTCL have response rates between 30% and 50% with response durations being less than a year. New studies looking at combination or maintenance therapies may improve quality of life and disease outcome.
